Flashcards in Pestana Orthopedics Deck (65):
A newborn has uneven gluteal folds and hips that click when pushed posteriorly? Tests? Treatment?
Congenital hip dysplaisa. Sonogram. Abduction splinting with Pavik harness for 6 months.
A 6 year old presents with limping, decreased hip motion, and pain in the knee and hip? Tests? Treatment?
Legg-Calve-Perthes - avascular necrosis of femoral epiphysis = osteonecrosis. AP and lateral hip Xray. Casting and crutches.
A 13 year old boy presents with groin and knee pain and limping? Physical exam sign? Tests? Treatment?
Slipped capital femoral epiphysis. When legs dangle off table, one sole points towards the other foot (can't rotate internally). X rays. External fixation of the hip joint with pins.
A feverish 4 year old develops hip pain and refuses to let anyone move it? Tests? Treatment?
Septic hip. Aspiration and drainage.
A feverish 4 year old develops severe localized pain in a leg bone that has experienced no trauma? Tests? Treatment?
Acute hematogenous osteomyelitis. MRI. Antibiotics.
Complications from Genu Varum?
If it persists beyond 3 years old, it's Blount disease (issue with medial proximal tibial growth plate). Repair surgically.
A 6 year old has genu varus? Should this be surgically repaired?
No, it’s normal between 4-8 year olds.
A 15 year old presents with knee pain (without swelling) over the tibial tubercle? Treatment?
Osgood Schlatter. RICE, cast in worst case scenario.
Treatment for club foot?
Serial plaster casts - Fix the adduction, the varus, and the equinus (in that order). Surgery preformed within first year if plaster doesn't work.
Diagnosis and treatment of scoliosis?
Look at her back as the patient bends over and note a hump over her right thorax. Bracing, and potentially surgery to avoid pulmonary issues.
Which locations do children have difficult healing from fractures?
Supracondylar fracture of the humerus, any bone that involves a growth plate.
A child falls on their hand with their arm extended, hyperextending the elbow? Complications? Treatment?
Supracondylar fracture of the humerus. Volkmann contracture and compartment syndrome. Casting (some require surgery).
Treating fracture in with epiphyses and growth plate are in one piece? Two pieces?
Closed reduction. Open reduction and internal fixation.
A 20 year old complains of three months of persistent low grade leg pain? Tests and Sign?
Osteogenic sarcoma. X rays with sunburst pattern.
A 10 year old complains of three months of persistent low grade leg pain. Tests and sign?
Ewing sarcoma. X rays with onion skinning pattern.
Are malignant bone tumors in adults typically primary or malignant? How does the lesion quality different according to gender.
Malignant. Lytic - breast. Blastic - prostate.
A 70 year old man presents with fatigue, anemia, and localized bone pain in several bones? Tests? Treatment?
X rays (punched out lesions). Urinalisys (bence-jones proteins). Serum immunoelectrophoresis (abnormal immunoglobulins), Chemotherapy or Thalidomide.
Where do sarcomas metastasize? Diagnostic test? Treatment?
Lungs (not nodes). MRI. Wide excision and chemoradiation.
Where do the majority of clavicular fractures occur?
Junction of muddle and distal thirds (the middle).
In anterior dislocation of the shoulder, some patients complain of numbness over the deltoid. What causes this?
Stretching of the axillary nerve.
A patient presents clutching their internally rotated arm after suffering a massive seizure? Tests?
Posterior shoulder dislocation. Axillary or scapular lateral X rays.
A 70 year old osteoperotic woman presents with a painful wrist that looks like a dinner fork after falling on her outstretched hand? Treatment?
Colles fracture. Closed reduction and long cast.
After being struck by an attack with a bat, a patient presents with a swollen and painful arm? Treatment?
Monteggia fracture. ORIF for diaphyseal fracture of the proximal ulna and closed reduction for anterior dislocation of radial head).
Galeazzi fracture? Treatment?
ORIF for fradctured radius and closed reduction for dorsal dislocation of the distal radioulnar joint.
A young man presents with wrist pain after falling on an outstretched hand. PE reveals localized tenderness over the anatomical snuffbox? Tests? Treatment (depending on test results)?
Scaphoid fracture. Displaced fractures will show up on xray immediately (undisplaced after 3 weeks). ORIF if displaced, 6-12 months of casting if non-displaced.
A man complains of a swollen and tender hand after punching a wall? Tests? Treatment for mild and severe cases?
Metacarpal neck fracture. X rays. Mild - closed reduction. Severe - wire fixation.
An old lady slips and falls on her hip in the snow. What will she look like in the stretcher?
Hip fracture, affected leg is shortened and externally rotated.
Treatment of intertrochanteric fractures? Complications and therapy?
ORIF and immobilization. Risk of DVT or PE. Post op anticoagulation.
A man suffers multiple open compound fractures from a motorcycle accident? Treatment? Complications?
OR cleaning and closure within 6 hours. Fat embolism with subsequent respiratory distress.
A man is hit by a car and compains of severe leg pain? Tests? Treatment for mild and severe? Complications?
Tib/fib fractures. Casting or intramedullary nailing. Compartment syndrome.
During a game of tennis, a man planted his foot and hears a loud pop from his ankle. He falls to the ground in pain. Tests? Treatment
Achilles rupture. Palpation of the tendon. Casting in equinius position or surgery (faster).
How are fractured ankles diagnosed and treated?
AP, lateral, and mortise x rays identify broken malleoli. ORIF.
A man was hit by a far and suffered a mild fracture in his tibia. He undergoes a closed reduction, but a few days later complains of excruciating pain with passive extension and a very tight and tender limb? Treatment?
Compartment syndrome. Fasciotomy.
A man suffers a head on collision and is brought to the hospital complaining of hip pain? How will they look on the stretcher? Treatment?
Posterior dislocation of the hip. Leg is shortened, adducted, and internally rotated. Emergency reduction to avoid complications from avascular necrosis.
A man steps on a rusty nail while cleaning up after his horses. A few days later he looks very sick? Describe the wound site? Treatment?
Gas gangrene. Tender, swollen, discolored, and has gas crepitus. IV penicillin, surgical debridement, and hyperbaric oxygen therapy.
A man with a fractured humerus is unable to extend his wrist, but regains the ability to do so after the humerus is reduced and put in a sling. Which nerve was affected? What vignette is associated with injury to this nerve?
Radial nerve. Saturday night palsy.
After jumping off a three story building, a man presents with fractured malleoli and tibia. Where else should you look to see for fractures?
Get an MRI to look at his lumbar and thoracic spine.
A female receptionist complains of numbness and tingling on the radial side of her hand that gets worse at night? Which nerve is effected? Tests? Treatment?
Carpal tunnel syndrome. Median nerve. X ray (including carpal tunnel view). Anti inflammatories and splinting, surgery if progresses.
A female wake up in the middle of the night with her finger flexed, she can snap it back but it is painful to do so? Treatment?
Trigger finger. Steroids, surgery as last resort.
A mother complains of pain along the radial side of her wrist a month after the birth of her child? Treatment?
De Quervain tenosynovitis. Steroid injection.
An older Norwegian man is unable to place his hand flat on a table, and has a palpable palmer nodule? Treatment?
Dupuytren's contracture. Surgical repair.
A febrile patient presents with a throbbing pain in his fingertip? Treatment?
Felon. Surgical drainage.
A skier complains of thumb pain after falling in the snow? Which structure is damaged? Treatment?
Gamekeeper's thumb. Hyperextension of the ulnar collateral ligament. Casting.
A man injures his middle finger while attempting to pull a flag during a flag football game. When he attempts to make a fist, his middle finger will not properly close? Treatment?
Jersey finger (flexor hyperextension). Splinting.
A volleyball player jams her finger during a game. Clinical sign? Treatment?
Mallet finger. Distal injured finger flexes when the rest of the hand is extended. Splinting.
A 45 year old man has several months of vague pain with intermittent shooting pain while coughing, defecating, or sneezing? How does the terminal location of the shooting pain pinpoint the location of the injury? Which physical test induces excruciating pain? Tests? Treatment? Complications?
Lumbar disk herniation. If exits on the big toe side (L4-L5) if little toe side (L5-S1). Straight leg extension test. Bed rest, nerve block, potential surgical intervention if very severe. Cauda Equina syndrome.
What is cauda equina syndrome? Treatment?
Distended bladder, flaccid rectal sphincter, perineal anesthesia after nerve injury. Immediate surgical decompression of the nerve.
A 40 year old man complains of chronic back pain that is worse in the morning and at rest. Tests and clinical sign? Treatment? Associated conditions?
Ankylosing spondylitis. Xray and bamboo spine. Antiinflammatories and physical therapy. HLA B-27 antigen - uvevitis and IBD.
An elderly man presents with progressive back pain and recent weight loss. He also complained of urinary symptoms? Tests?
Metastatic prostate cancer. MRI.
A patient presents with a PMH of atherosclerosis and notes dirty looking ulcers on the tips of his toes? Tests? Treatment?
Ulcer from arterial insufficency. Doppler studies and CT angio. Surgical revascularization or stenting.
A patient with limited mobility with PMH of varicose veins and cellulitis notices edematous, hyperpigmented, hard lesion on the medial side of their ankle? Tests? Treatment?
Venous stasis ulcer. Duplex scan. Ace bandages, compression stockings, potentially surgery.
A patient with PMH of 3rd degree burns on his legs develops a dirty looking dep ulcer, with heaped up edges at the former burn site? Tests? Treatment?
Marjolin ulcer (Squamous Cell Carcinoma). Biopsy. Wide local excision and skin grafting.
An overweight man complains of sharp heel pain every time it strikes the ground. The pain is worse in the morning? What is often found during testing? Treatment?
Plantar fasciitis. X rays identify bony spurs (not he cause of the pain). Pain resolves over a year, so symptomatic management of pain/support sleeves
A woman complains of a very tender spot between her third and fourth toes? Cause?
Morton Neuroma - inflammation of the common digital nerve. Tight shoes that force the toes together.
An overweight man complains of a red, painful big toe? Tests? Acute treatment? Chronic Treatment?
Gout. Bifringent uric acid crystals in the joint fluid. Indomethacin (NSAID) and Colchicine. Allopurinol (xanthine oxidase inhibitor) or Probenicid.
Valgus stress test demonstrates what sort of injuries? Varus stress test demonstrates what sort of injuries?
Anterior drawer test is preformed for which injury? Associated injuries?
ACL tear. Terrible triad - ACL, MCL, medial meniscus tear.
After a basketball game, a patient presents with a swollen and painful knee. He claims he experienced a pop when the injury occurred, and the swelling got worse several hours later. The knee locks, and it makes a click sound when forcefully extended? Tests? Treatment?
Meniscus tear. MRI. Open repair.
What vascular structures can be injured in posterior knee dislocations? Tests? Complications (2)?
Popliteal artery injury. Check pulses and Doppler/CT angio. Ischemia and Compartment syndrome
A patient presents with a non healing ulcer on the plantar surface below the first metatarsal bone?
Diabetic peripheral neuropathy.
How to treat a femoral shaft fracture.
Closed intramedullary fixation.
How to intubate an apneic patient with head injury?
A middle aged patient complains of unilateral surface hip pain that is worse when he lies on it?
A hairline metatarsal fracture should be treated by?
Rest, analgesics, and a hard soled shoe/boot.